2013-10-25T15:39:07-05:00 2012-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2012-01-01 362196729 CEMENT MASONS INSTITUTE LOCAL 502 WELFARE TRUST FUND CEME 7085449105 739 25TH AVENUE BELLWOOD IL 60104 PATRICK J LA CASSA 7085449105 2013-10-25 1 BRUCE A PAVLIK P00748405 3123680500 2012 2016-03-07 17:11:31Z PATRICK J LA CASSA 739 25TH AVENUE BELLWOOD IL 60104 53528842 0 X N/A X 1950 IL PROVIDE HEALTH BENEFITS 12 0 21 0 0 0 0 0 10320364 13929093 409396 1092178 3258 3216 10733018 15024487 0 0 10209107 12990773 494027 785424 0 0 0 815846 921500 11518980 14697697 -785962 326790 26065331 34229188 254252 1561485 25811079 32667703 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE MEDICAL AND LIFE INSURANCE TO PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 10 0 1 21 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X WILLIAM BEEMAN 7085449105 739 S 25TH AVENUE BELLWOOD IL 60104 MICHAEL PIRRON 2.00 0.00 X 0 0 0 SANDRA HUNT 2.00 0.00 X 3586 0 1891 PAUL REDMANN 2.00 0.00 X 3586 0 580 GARY LUNDSBERG 2.00 0.00 X 0 0 0 ROBERT KRUG 2.00 0.00 X 0 0 0 CURT ERICKSON 2.00 0.00 X 3586 0 0 DOMINIC FARRELL 2.00 0.00 X 3586 0 1891 DONALD DEETJEN 2.00 0.00 X 0 0 0 LAWRENCE PICARDI SR 2.00 40.00 X 0 111993 77684 PATRICK WILHARM 2.00 0.00 X 0 0 0 RUSSEL SIMONCELLI 2.00 40.00 X 0 98316 63690 MICHAEL KOLBERG 2.00 0.00 X 0 0 0 PATRICK LA CASSA 2.00 40.00 X 0 112908 77755 JOSEPH RIVECCO 2.00 0.00 X 2233 0 1537 WILLIAM BEEMAN 21.50 28.50 X 110707 0 17237 127284 323217 242265 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 PPO PROVIDER 426085 ARNOLD & KADJAN 203 N LASALLE ST STE 1650 CHICAGO IL 60601 LEGAL 189538 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE SUITE 4000 CHICAGO IL 60606 AUDITOR AND PAYROLL COMPLIANCE AUDITOR 160780 GROUP ADMINISTRATORSLTD 915 NATIONAL PARKWAY SCHAUMBURG IL 60173 CONTRACT CLAIMS ADMINISTRATOR 135777 4 CONTRACTOR CONTRIB. 900099 13022928 13022928 REIMBURSED ADMN EXP 900099 389472 389472 PARTICIPANT SELF-CONTR. 900099 378078 378078 PRESCRIPTION DRUG REBATES 900099 101570 101570 MEDICARE PART D SUBSIDY 900099 37045 37045 13929093 558448 558448 39038085 38504355 533730 533730 533730 MISCALLENOUS INCOME 900099 3216 3216 3216 15024487 13539621 0 1484866 12990773 146817 362377 160862 74973 40395 189538 223056 25993 210349 67527 39078 61574 8895 43175 27271 25044 14697697 450522 2017222 1624291 1349618 1127809 1918120 81609 293855 59773 249994 206262 44938 43732 16852836 27864191 5883326 682677 26065331 34229188 254252 1561485 254252 1561485 X 0 0 0 0 25811079 32667703 25811079 32667703 26065331 34229188 X 326790 391582 6138252 X 0 1 X 1 0 87646 87067 579 137888 106965 30923 24460 12230 12230 43732 X 15000604 391582 391582 14609022 25993 389472 415465 15024487 14282232 0 14282232 25993 389472 415465 14697697 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRE. PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMINISTRATIVE EXPENSES 389,472. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMINISTRATIVE EXPENSES 389,472. X 0 0 0 LAWRENCE PICARDI SR 0 111085 0 0 0 908 0 49099 0 28585 0 189677 0 0 RUSSEL SIMONCELLI 0 92296 0 0 0 6020 0 40149 0 23541 0 162006 0 0 PATRICK LA CASSA 0 111903 0 0 0 1005 0 49170 0 28585 0 190663 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND FUND ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARDS' REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES AND THE FUND ADMINISTRATOR SHALL REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THIS POLICY TAKING ALL STEPS THEY DEEM NECESSARY TO ENSURE SUCH MONITORING AND ENFORCEMENT. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS FROM LOCAL 803 WELFARE FUND 6,138,252. PENSION FUND OF CEMENT MASONS' UNION LOCAL NO 502 739 25TH AVENUE BELLWOOD IL 60104 516034597 PROVIDE DEATH AND RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 401(A) N/A N/A 0 CEMENT MASONS LOCAL NO 502 SAVINGS FUND 739 25TH AVENUE BELLWOOD IL 60104 366411337 SAVINGS PLAN IL 501(C)(9) N/A N/A 0 CEMENT MASONS LOCAL NO 502 APPRENTICE EDUCATIONAL & TRAINING 739 25TH AVENUE BELLWOOD IL 60104 362487783 TO TRAIN AND EDUCATE APPRENTICES AS CEMENT MASONS. 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